Rehabilitation Curriculum
Course Description
This course will focus on rehabilitation and patient care. Topics include complications to inactivity, positioning, transfers, body mechanics, gait, assistive devices, adaptive equipment, fall prevention, wheelchairs, total joint arthroplasty, prosthetics and orthotics, range of motion and exercise.
Course Objectives
The general objective of this course are to provide nursing assistance with education concerning rehabilitation and patient care. Upon successful completion of this course, the student should be able to:
1. Describe the role of the rehabilitation team and nursing assistant with patient care.
2. Identify complications from immobility.3. Demonstrate levels of assistance, patient positioning
and transfers.4 .Demonstrate good body mechanics during tasks.5. Demonstrate the ability to safely assist patients
during ambulation and transfers.6. Demonstrate the proper use of assistive devices with
ambulation.
Course Objectives Continued
7. Identify the demonstrate the basic phases of gait.8. Identify possible factors related to falls in the elderly.9. Identify wheelchair components and their function.10. Demonstrate the use of adaptive equipment.11. Demonstrate and identify through analysis of case
studies and laboratory experience compliance with orthopedic precautions.
12. Identify the use of orthotics and prosthetics.13. Describe the benefits of exercise.14. Demonstrate the anatomical planes of motion.15.Demonstrate skilled technique when performing
rom.
What is Rehabilitation?
A process in which an individual is assisted in reaching their highest level of function and ability.
The Rehabilitation Team
PHYSICAL THERAPISTOCCUPATIONAL THERAPISTSPEECH -LANGUAGE PATHOLOGIST
RESPIRATORY THERAPIST
PHYSCIAL THERAPIST
Evaluate and treat people with health problems resulting from injury or disease.
PTs assess joint motion, muscle strength, endurance, balance, mobility and function.
Develop a plan of care appropriate for the patients needs.
Provide instruction and education to the patient and caregivers.
Progress the patients mobility and function to the fullest possible level.
Occupational Therapist
Evaluate and treats people with problems arising from developmental deficits, physical illness or injury, emotional or cognitive disorders.
Develops a plan of care to restore self care, work and leisure skills.
Assists the individual in acquiring the knowledge, skills, and attitudes needed for the performance of activities of daily living (ADL)
Speech-Language Pathologist
Evaluate and treat individuals with speech, language, cognition, voice disorders.
Evaluate and treat individuals with swallowing disorders.
Treatments include, physical strengthening exercises, instructive repetitive practice, use of audio-visual aids and the introduction of strategies to facilitate functional communication and swallowing.
Respiratory Therapist
Evaluate and treat individuals with breathing disorders.
Disorders include: asthma, bronchitis, emphysema, COPD, heart attach, stroke or trauma, complications at birth, and other disorders.
The Role of the Nursing Assistant and Rehabilitation
PROM, AAROM, AAROMPOSITIONING PREVENT COMPLICATIONS SUCH AS
PRESSURE ULCERS AND CONTRACTURESMOBILITY TO INCREASE THE INDIVIDUALS
ABILILTIES OR TO MAINTAIN CURRENT ABILITIES
BATHING AND PERSONAL CARE PROCEDURES
ENCOURANGE THE INDIVIDUAL TO PERFORM ADLS TO THE FULLEST EXTENT POSSIBLE
Complications from Inactivity
Weakness and limitations in mobilityContracturesDisuse osteoporosisPressure UlcersDecreased cardiovascular and respiratory
functionDecreased gastrointestinal system functionBladder infections and incontinenceDepression
Complications form Inactivity
Weakness and limitations in mobility
Muscles become weak and atrophy, how can this effect the individual?
Complications from Inactivity
Contractures Muscle contractures are a result of
prolonged immobility and or improper positioning leading to joint stiffness and decreased range of motion.
What can be done to prevent muscle contractures?
Complications from Inactivity
Disuse osteoporosis
Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue leading to fragility and risk of fracture.
How can this effect the individuals mobility?
Complications of Inactivity
Pressure Ulcers Pressure ulcers are lesions caused by
unrelieved pressure to any part of the body, especially portions over boney areas.
What areas of the body could be at risk?
Complications of Inactivity
Decreased cardiovascular and respiratory function
The heart must work harder to pump blood through the body.
The lungs do not expand as fully resulting in decreased efficiency with respiration.
How could this prevent an individuals participation during ADLs?
Complications of Inactivity
Gastrointestinal system function
Appetite may decrease, causing weight loss. Peristalsis slows down, causing indigestion
and constipation. Risk of choking and aspiration due to
improper positioning.
What position would be best during meals?
Complications of Inactivity
Bladder infection and incontinence
Decreased ability for the bladder to empty completely.
Decreased ability to transfer to toilet or commode.
How could increased activity benefit an individual during transfers?
Complications of Inactivity
Depression
Can occur from physical and mental inactivity.
How can increased activity benefit an individuals quality of life?
The Nursing Assistant and Patient Care
A Study of 599 older adults ( age 85 and above) noted the prevalence of disability, defined as inability to perform one or more ADLs, was 64% for women and 55% for men.
The prevalence of disability defined as inactivity was 92% for women and 98% for men.
Note the significant difference between ability and functional activity.
Resnick 2004
The Nursing Assistant and Patient Care
Encourage increased participation in ADLs.Motivate and provide immediate
reinforcement for performing a dressing task.Encourage participation in regular care
activities.Promote activity, mobility and independence
in daily activities.Promote increased involvement and
socialization with others.
The Nursing Assistant and Patient Care
You are making a difference by encouraging and
Supporting your patients!
How can you encourage increased participation during ADLs with your patient?
Levels of Assistance, Positioning, Transfers
Levels of Assistance
IndependentIndependent with adaptive deviceSetupSupervision or stand by assistanceCueing
Levels of Assistance
Minimum Assistance
Moderate Assistance
Maximum Assistance
Levels of Assistance
Minimum Assistance
Patient performs 75% or more of activity.
Levels or Assistance
Moderate Assistance
Patient performs 50% to 74% of activity.
Levels of Assistance
Maximum Assistance
Patient performs 25 % to 49 % of activity.
Body Alignment and Positioning of the Patient
Body Position Fowler’s Prone Supine Lateral Sim’s Sitting
Body Alignment and Positioning of the Patient
Fowler’s PositionA semi-sitting positionHead of the bed is raised between 45 and 90
degreesKeep the spine straightSupport the head with a pillowSupport the arms with a pillow
Body alignment and Positioning of the Patient
Prone On the abdomen, head to one side with a
small pillow under the headPillow under the abdomen to relieve pressure
to the chest and backPillows under the lower legs to prevent
pressure on the toes
Body Alignment and Positioning of the Patient
Supine Position The bed is flatPatient positioned on their backThe head and shoulders are supported by a
pillowSmall pillow under lower legs relieves
pressure on the ankles and heelsElevate knees to relieve pressure on the low
back
Body Alignment and Positioning of the Patient
Lateral PositionThe bed is flatUpper leg is in front of the lower leg
supported by a pillowPillow positioned along the patients backPillow under the upper hand and arm
Body Alignment and Positioning of the Patient
Sim’s PositionLeft side-lying positionUpper leg flexed, not resting on lower legPillow supporting upper leg and thighPillow supporting head and shoulderPillow supporting upper arm and hand
Body Alignment and Positioning of the Patient
Sitting90-90-90!Back and buttocks against the back of the
chairFeet flat on the floor or footplates of
wheelchairDo not allow back of knees to rest against the
chair
Body Alignment and Positioning of the Patient
Always follow the patients individual plan of care for positioning and mobility.
Body Alignment and Positioning of the Patient
Lifting and Moving Patients in Bed Precautions
FrictionShearing
Body Alignment and Positioning of the Patient
FrictionOccurs when the skin is rubbed against
another surface.
ShearingOccurs when the skin moves in one direction
and other structures remain fixed.
Give examples of how friction or shearing can happen.
Body Alignment and Positioning of the Patient
Before Positioning of the PatientFollow the patients plan of careAsk a coworker for helpPractice good hygieneIdentify the patient and explain the
procedure to the patientPrivacy and drapingLock the bed wheelsRaise the bed for proper body mechanics
Body Alignment and Positioning of the Patient
Turning the Patient Towards YouCross the patient’s far arm over their chest.
Bend the elbow of the near arm, bringing the hand to the head of the bed.
Place one hand on the patient’s far shoulder and one on the patient’s hip.
Gently roll the patient toward you in a smooth motion
Put up side rails and utilized pillows for comfort and support
Body Alignment and Positioning of the Patient
Turning the Patient Away from YouHave the patient bend his knees and cross their armsPlace your one arm under the patients head and
shoulders The other hand and forearm under the patient’s low
backKeep your back straight and bend your body at the
hips and kneesGently pull the patient toward youRoll the patient slowly and carefully away from you
by placing one hand on the patient’s shoulder and one under the hips.
Body Alignment and Positioning of the Patient
Moving the Patient to the Head of the BedLift top bedding and expose draw sheetNursing assistant on each side of the patientGrasp the draw sheet or place one arm under
the patient’s thighs and other under the shoulders
On the count of three move the patient smoothly towards the head of the bed
Use pillows for comfort and positioning
Body Alignment and Positioning of the Patient
Logrolling the PatientMay be indicated for patient’s that have had
spinal injury or surgeryPlace a pillow between the patient’s legsThe patient’s arms are crossedUsing a turning sheet Roll the patient towards youTurn the patient as a unit
Transfers
Transfer GuidelinesKnow your patients required level of assistanceKnow the method of transferUse a transfer belt unless contraindicatedNever pull on a patient’s arms or shouldersAlways lock the wheels on the bed and
wheelchairAlways have the patient wear nonskid footwearPrepare the area…be aware of tubes, orthotics
or other equipment in the area
Transfers
Transfer Guidelines ContinuedTransfer the patient to their strongest sideAlways explain the procedure to the patient
and test the patients understandingStand close to the patientEncourage appropriate body alignmentAllow the patient to assist as much as
possible
Transfers
Transfer BeltAlways apply over clothingTighten the belt snugThe belt should not cause discomfort or
restrict breathingBe able to slide your open hand under the
beltDo not position the buckle over the spine
Transfers
Bed to ChairHave the chair positioned along the bed wheels
locked Stand in front of the patientPatient seated at the edge of the bedPatients feet flat on the floorGrasp the transfer belt from underneathBrace your knees against the patients kneesAsk the patient to push down on the mattress and
stand on the count of three.Pull the patient to a standing position
Transfers
Bed to Chair ContinuedSupport the patient in a standing positionTurn the patient and ask the patient to grasp
the far arm of the chairContinue to turn the patient to the front of the
chairGently lower the patient as you bend your kneesMake sure the patient is properly positioned
and comfortableRemove the transfer belt
Bed to Chair with Two AssistantsNursing assistance on each side facing the
patientPatient seated at the edge of the bedPatients feet flat on the floorEach assistant grasps the transfer belt from
underneath. The other hand grasps the belt from the back
Nursing assistant closest to the chair has room to pivot to allow patient access to the chair
Brace your knees against the patients knees
Transfers
Transfers
Bed to Chair with Two Assistance ContinuedAsk the patient to push down on the mattress
and stand on the count of three.Pull the patient to a standing positionBoth nursing assistance assist the patient to
turn slowly and smoothly towards the chairGently lower the patient as you bend your
kneesMake sure the patient is properly positioned
and comfortableRemove the transfer belt
Transfers
Sliding-Board Transfers
Slide-boards are used with patients with good upper body strength and sitting balance.
Requires wheelchair with removable arm rests and swing away leg rests.
Patients must have clothing on their lower body to prevent friction and shearing
Transfers
Mechanical liftUsed for transfers of heavy patients with
decreased ability.Mechanical lifts vary in style and function.Make sure you are trained in the use of the
mechanical lift at your facility.Always check slings, straps, hooks and chains
for safety.Make sure the patient’s weight does not
exceed the recommendation of the manufacture.
Transfers
Case studyMr. Jones recently underwent spinal surgery
and requires assistance for bed mobility and transfers. Per MD orders Mr. Jones is not to twist or turn his back. Which method would be best to assist Mr. Jones to a side lying position?
Body Mechanics, Ambulation and Mobility
Body Mechanics
Body Mechanics
The way we move during an activity.Proper body mechanics involves good posture, balance and using stronger body parts for work.
Good body mechanics reduces your risk for injury.
Body Mechanics
Body Alignment
The way the head, neck, trunk, arms and legs align with each other.
Good alignment is essential for efficient safe function and movement.
Body Mechanics
Base of Support
Is the area in which an object rests.
In standing a wide base of support gives you greater stability.
Body Mechanics
Rules for Good Body MechanicsIt is easier to pull, push or roll an object than to liftAvoid jerky movementsUse the larger leg and arm musclesKeep the work as close to your body as possibleKeep the work at a comfortable height to avoid
bendingKeep your body in good physical condition to
reduce injuryKeep your body in good alignment with a wide base
of support
Body Mechanics
Lifting
Use the strong muscles of the legs for lifting.Bend at the knees and hip, keep your back
straight.Lift straight upward in a smooth motion.
Body Mechanics
Reaching
Stand directly in front of and close to the object.
Avoid twisting or stretching.Maintain good alignment and base of support.Be cautious of moving heavy objects.
Body Mechanics
Pivoting
Place one foot slightly ahead of the other.Turn both feet at the same time, pivot on the
heel of one foot and toe of the other.Maintain good alignment and base of support.
Body Mechanics
Avoid Stooping
SquatAvoid bending at the waistUse the strong muscle of the leg to return to
upright position.
Ambulation and Mobility
AmbulationThe act of walking.
GaitThe way in which a person walks.
Ambulation and Mobility
Normal Gait Pattern
Repeats a basic sequence of limb motions that serve to progress the body along a desired path while maintaining weight-bearing stability.
Ambulation and Mobility
Gait is divided into two phases
Stance – The entire time the foot is on the floor.
Swing – When the foot is off the floor.
Ambulation and Mobility
Body Alignment and Posture
The patient must be able to stand straight on one leg as he swings the other leg to take a step.
Ambulation and Mobility
Gait TipsStand on the patients affected sideUse a gait belt if the patient requires assistancePatient should stand as erect as possibleFeet should be 4 to 6 inches apartWith each step the heel should land on the floor
firstProper foot wearPrepare the area, clear walkwaysSafe use of assistive device
Ambulation and Mobility
Gait Tips Continued
Allow adequate timeEncourage large even stepsAllow the patient to do as much as they canWhen turning, avoid sharp pivots or twisting Make shorter steps when turning
Ambulation and Mobility
Gait Tips ContinuedAvoid letting the upper body get ahead of the
lower bodyDo not lean upper body too far forwardDon’t rushIf your patient shows signs of illness notify
the nurseNever leave your patient unattended
Ambulation and Mobility
Assistive Devices for Ambulation
CrutchesCanesWalkers
Ambulation and Mobility
Crutches
Typically not recommended for older adultsLofstrand crutches have a cuff that surrounds
the forearmPlatform Crutches permit weight-bearing on
the forearm
Ambulation and Mobility
Canes
Quad canes have four prongs and offer a wide base of support.
Single pronged cane are for assisting with balance
Canes are used on the strong side of the bodyThe patient will use a two point or three point
gait
Ambulation and Mobility
Two Point GaitCaneAffected legUnaffected leg
Three Point GaitCane, affected legUnaffected legWhen there is no affected leg, weight bearing
is equal on both legs.
Ambulation and Mobility
Weight bearing is the amount of weight that may be applied on an extremity.
Non-weight bearingToe touchPartial weight bearingWeight bearing as toleratedFull weight bearing
Ambulation and Mobility
Non-weight bearing: lower extremity not to bear weight and usually not permitted to touch the ground.
Toe touch: the patient can rest the toes of the involved lower extremity on the ground for balance, but not weight bearing.
Ambulation and Mobility
Partial weight bearing: A limited amount of weight bearing, such as five pounds, unless a specific amount is confirmed by the MD.
Weight bearing as tolerated: The amount of weight bearing may vary from minimal to full, depending on the patients tolerance.
Full weight bearing: Full weight bearing is permitted.
Ambulation and Mobility
Walkers
StandardWheeledplatform
Ambulation and Mobility
Disorders Which Can Affect Gait
StrokeMultiple sclerosisHuntington’s diseaseParkinson’sArthritisAmputationsOrthopedic issues
Ambulation and Mobility
Stroke (Cerebral vascular Accident)
A blockage or hemorrhage of a blood vessel leading to the brain, causing inadequate oxygen supply and damage to brain tissue.
May result in hemiplegia, loss of body control, dysphagia (swallowing issues), Aphasia, speech impairments, Changing emotions, impaired memory, urinary incontinence or frequency
Ambulation and Mobility
Multiple Sclerosis
A chronic degenerative disease of the CNS which destroys the myelin sheath the surrounds the nerves.
May result in muscle weakness, visual impairments, tremors, numbness, speech issues, dizziness, memory and judgment, bowel and bladder dysfunction.
Ambulation and Mobility
Huntington’s Disease
A hereditary disease of the CNS characterized by brain deterioration and loss of control over voluntary movements, speech impairments, mental deterioration.
Ambulation and Mobility
Parkinson’s Disease
A progressive nervous disease associated with the destruction of brain cells that produce dopamine.
May result in tremors, stiff muscles, slow movement, stooped posture and impaired balance, mask-like expression, swallowing issues, memory and speech, bladder impairments
Ambulation and Mobility
Arthritis
Acute or chronic inflammation of the joint resulting in pain and stiffness.
Ambulation and Mobility
Amputations
Patient may have a prosthesis.
Ambulation and Mobility
Orthopedic Issues
An injury or disorder or recent surgery of the musculoskeletal system.
Fall Prevention, Adaptive equipment,
Wheelchairs
Fall Prevention
Falls are not part of the normal aging process. But are due to an interaction of factors.
Falls are due to:Impairments in mobilityUneven steps, shuffling gait, unsafe use of
assistive device
Fall Prevention
Falls are due to: Transfers difficulty with moving from sitting to
standing Drop sitting Landing too close to the edge of the seat
Fall Prevention
Falls are due to:Impaired standing balanceLeaning off centerLoss of balance when attempting to stand Loss of balance when bending or reaching
Fall Prevention
Falls are due to:
Multiple medications
Fall Prevention
Falls are due to:
Postural hypotensionCheck blood pressure
Fall Prevention
Falls are due to:
Impaired visionImpaired hearingImpaired position senseImpaired cognition
Fall Prevention
Falls are due to:
Improper footwearFoot deformities
Fall Prevention
Falls are due to:
Environmental hazardsObjects in walkwayInadequate lightingUnsafe stair management
Adaptive Equipment
Adaptive Equipment
Devices or equipment designed and fabricated to improve performance in activities of daily living.
Adaptive Equipment
Bathing and ToiletingLong handled spongeCurved bath brushHand held showerGrab barsTub seat/benchRaised toilet
Adaptive Equipment
Dressing
Dressing stickSock aidsReachersButton and zipper aidLong-handled shoehornElastic shoe laces
Adaptive Equipment
Eating
Comfort grip curved utensilsScoop dishPlate guardsDrinking mugs with large handles or covers
Wheelchair
The wheelchairPostural support- The surface that is in
contact with the user’s body.
Mobility base – Consists of the tubular frame, arm-rests, foot supports, and wheels.
Wheelchair
Wheelchair Brakes
Brakes must be engaged during a transferInspect the brake mechanism for safety
Wheelchair
Seat Belts
Prevents fallsAssists in positioningCheck POC for seat belt use
Wheelchair
Drive wheels – the large wheels used for propulsion
Outer rim – used by the patient to propel the wheelchair
Projections – for patients with decrease ability to grasp
Wheelchair
Armrests
Full lengthDesk lengthRemovable or fixedAdjustable height
Wheelchair
Footrests/Leg-rests
Fixed or removablePivoting or non-pivotingElevating leg-restsCalf supports
Wheelchair
Tilt in Space
A fixed back to seat anglePermits changes in orientation for pressure
relief and or different activities
Wheelchair
One Arm Drive
Applying pressure to one rim turns the wheelchair
Pump lever to provide propulsion
Wheelchair
Wheelchair Size
Seat depthSeat widthBack heightArmrest heightSeat to footplate lengthFootplate size
Total Joint Arthroplasty, Prosthetics and Orthotics
Total Joint Arthroplasty
Total Joint Arthroplasty
Also know as total joint replacementOver 400,000 procedures a year Primary candidates are people with chronic
joint pain from arthritisPurpose of surgery is to relieve pain and
restore function
Total Joint Arthroplasty
Total Knee Arthroplasty
Portions of the knee joint are replaced with metal and plasticComponents shaped to allowContinued motion of the knee.
Total Joint Arthroplasty
Total Knee Arthroplasty
Multidisciplinary teamorthopedic surgeon, nursing staff, rehab
team
Total Joint Arthroplasty
Total Knee ArthroplastyRehabilitation Phase 1: Inpatient acute care
Promotion of ROMIndependence with bed mobility, transfers
and gaitRestoration of safety and independence with
ADLs
Total Joint Arthroplasty
Continuous Passive Motion (CPM)A machine that performs PROM exercise on
the affected knee joint.
Often prescribed by orthopedic surgeons
Protocol varies always check with patients poc.
Total Joint Arthroplasty
Total knee ArthroplastyRehabilitation Phase II: Skilled Nursing FacilityGoals are the same as Phase IEducation of family members and caregiversPlanning of homecare needs
Total Joint Arthroplasty
Total Knee ArthroplastyRehabilitation Phase III: Outpatient Home
HealthFocus on safety in home Progression of ROM, transfers, gait and ADLs
Total Joint Arthroplasty
Total Hip Arthroplasty
The hip joint is preplaced by a prosthetic implant.
Total Joint Arthroplasty
Total Hip Precautions
Patients should not:Flex the hip more than 90 degreesCross the affected leg over midlineInternally rotate the hip
Check weight-bearing precautions
Total Joint Arthroplasty
Total Hip Arthroplasty
Rehabilitation Phase I: Inpatient acute care
Education regarding precautions with transfers and movements
Postoperative exercises: Ankle pumps, quad sets, gluteal sets, heel slides.
Total Joint Arthroplasty
Total hip precautions
Rehabilitation Phase II: Skilled Nursing FacilityReinforce total hip precautionsIncrease independence with gait and
transfersPrepare for safety in homeProgress to outpatient home health care
Total Joint Arthroplasty
Equipment Needs
Raised toilet seatTub bench or seatAdaptive equipment to assist with ADLsWalker, crutches or cane
Prosthetics and Orthotics
Prosthetics and Orthotics
Prosthesis - An artificial extension that replaces a missing body part.
Orthotic- a device that serves to protect, restore or improve function.
Prosthetics and Orthotics
Principal Lower Limb Prosthetics
Partial footBelow kneeAbove kneeKnee and hip disarticulation
Prosthetics and Orthotics
Partial Foot
Trans-metatarsal AmputationPatient bears most weight on the heelDecreased time on the affected foot during
gaitPlastic socket fixed to a rigid plateProtects amputated ends
Prosthetics and Orthotics
Below Knee
Tibia and Fibula is transectedKnee joint is intactProstheses include a foot-ankle assembly and
socket Limb fits into a custom molded socket
Prosthetics and Orthotics
Above Knee
Amputation between the femoral epicondyles and greater trochanter
Prosthesis consists of foot-ankle assembly, shank, knee unit, socket and suspension device
Prosthetics and Orthotics
Hip Disarticulation
Amputation of the femur and or part of the pelvis
Prosthesis has hip, knee and foot assemblies Plastic molded socket to support weight on
remainder of pelvis
Prosthetics and Orthotics
The Rehabilitation Team
Works closely with the physician and prosthetist
Trains the patient to don, use and maintain the prosthesis
Prosthesis and Orthotics
Lower Limb OrthosesFoot orthoses (FO)Ankle foot orthoses (AFO)Knee ankle foot orthoses (KAFO)Hip knee ankle foot orthoses (HKAFO)
Prosthetics and Orthotics
Foot Orthosis
May be an internal modification in the shoe or external modification
Can enhance function by relieving pain and improving the quality of gait
Prosthetics and Orthotics
Ankle- foot orthoses
orthosis consists of the shoe and plastic or metal component
Most AFOs prescribed to control ankle motion by limiting plantar-flexion and or dorsi-flexion, or by assisting motion
Provides stability
Prosthetics and Orthotics
Knee ankle foot orthosesConsists of shoe, ankle control, knee control
and superstructureMost KAFOs include a pair of uprights and
knee hinges
Prosthetics and Orthotics
Hip knee ankle foot orthoses
Addition of a pelvic belt band and hip joints converts the KAFO to an HKAFO
Hip joint is usually a metal hinge which prevents abduction, adduction and hip rotation
Exercise and Range of Motion
Exercise
What is Exercise?
A physical activity done to improve or maintain one or more components of physical health.
Exercise
Why Exercise?Increased strengthIncreased balanceIncreased enduranceIncreased flexibilityIncreased skill in an activityIncreased independence
Exercise
Forms of Exercise
AerobicIsometricActiveResistive
Exercise
Aerobic- sub maximal, rhythmic, repetitive exercise of large muscle groups, during which the needed energy is supplied by inspired oxygen
Exercise
Isometric- Exertion during which the muscle does not change length.
Exercise
Active- Exercise that is performed without any assistance.
Exercise
Resistive- Training with resistance to movement to increase muscle strength through the use of weights, bands, ones own body weight.
Range of Motion
Range of motion exercises are performed to prevent the development of contractures, muscle shortening, and tightness in capsules, ligaments and tendons.
Range of motion exercises enhance mobility and provide sensory stimulation with is beneficial to the patient.
Range of Motion
AROM – carried out independently by the patient
PROM – ROM performed without the assistance of the patient
AAROM- Carried out by the patient with assistance to facilitate normal muscle function.
Range of Motion
Anatomical Planes of MotionsFlexionExtensionAbductionAdductionOppositionInternal rotationExternal rotation
Range of Motion
Anatomical Planes of Motion Continued
SupinationPronationInversionEversion
Range of Motion
Range of Motion General Guidelines
Check the POC or ask the nurse of rehab team
Explain the procedure to the patientMake sure the patient is comfortably
positionedEncourage the patient to assist if able and
indicatedExpose only the body part you are exercising
Range of Motion
Range of Motion General Guidelines Continued
Support each joint by placing one hand above and one hand below the joint.
Watch the patients face for gestures which indicate discomfort. Stop! Reposition or use a lighter touch and or contact the nurse or rehab team
Only move the joint within its available range, never push past the point of resistance
Perform 3 to 5 repetitions slow and controlled ROM significantly improves joint functioning
Range of Motion
Precautions
Fractures or dislocationsOrthopedic precautionsWounds or pressure ulcersCombative or resistant patientsSpasticity or rigidity
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